Rhinitis

What is rhinitis?

Rhinitis is a reaction that occurs in the eyes, nose and throat when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

What are the different types of rhinitis?

The two categories of rhinitis are:

allergic rhinitis

There are two types of allergic rhinitis:

seasonal - occurs particularly during pollen seasons

perennial - occurs throughout the year

The most common causes of allergic rhinitis are:

pollen (tree, grass, weed)

dust mites

mold

cockroach droppings

animal dander

Reactions from allergic rhinitis include:

sneezing

congestion

runny nose

itchy nose, throat, eyes, and ears

nosebleeds

clear drainage from the nose

Persons with perennial allergic rhinitis may also have the following:

recurrent ear infections

snoring

breathing through the mouth

fatigue

poor performance in school

Preventive measures for avoiding allergic rhinitis include:

environmental controls, such as air conditioning, during pollen season

avoiding areas where there is heavy dust, mites, molds

avoiding pets

nonallergic rhinitis

Types of nonallergic rhinitis are:

vasomotor rhinitis (irritant rhinitis)

eosinophilic

rhinitis medicamentosa

neutrophilic rhinosinusitis

structural rhinitis

nasal polyps

primary vasomotor instability

Causes of nonallergic rhinitis include:

fumes

odors

temperature

hormonal changes

overuse of topical nose sprays

atmospheric changes

smoke

other irritants

Reactions from nonallergic rhinitis include:

sneezing

congestion

runny nose

itchy nose, throat, eyes, and ears

The preventive measure for avoiding nonallergic rhinitis is avoiding the primary cause.

Treatments for nonallergic rhinitis, as determined by your physician and based on your condition, may include:

oral medications

inhaled medications

immunotherapy

allergy injections

surgery (for some conditions)

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your physician based on a thorough history and physical examination. In addition to the above signs, the physician may find on physical examination dark circles under the eyes, creases under the eyes, swollen tissue inside the nose, and mouth breathing.

Treatment for allergic rhinitis:

Avoidance of the allergens that are causing the problem is the best treatment. Specific treatment will be determined by your physician based on:

your overall health and medical history

extent of the reaction

your tolerance for specific medications, procedures, or therapies

expectations for the course of the reaction

your opinion or preference

Treatment may include:

antihistaminesAntihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness.

nonsedating antihistaminesNonsedating antihistamines work like antihistamines but without the side effect of causing drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec) or loratadine (Claritin).

anti-inflammatory nasal spraysAnti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your physician about proper dosages.

steroid nasal spraysSteroid nasal sprays also help to decrease the swelling in the nose. Steroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up.

topical nasal decongestantsTopical nasal decongestants are not recommended for children. In some cases, they cause symptoms to worsen for children.

decongestantsDecongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription.

anti-leukotrienesThese are a relatively new type of medication being used to control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluid in the lungs. These are usually given by mouth.

If you do not respond to avoidance or to the above medications, your physician may refer you to an allergist for testing. The allergist then may recommend immunotherapy based on the findings. Immunotherapy usually involves a three to five year course of repeated injections of specific allergens to decrease the reaction to these allergens when you come into contact with them. Consult your physician for more information.

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis is a common problem that may be associated with asthma.

Guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.